An analysis of heart donation after circulatory determination of death

Abstract

Only death criteria based on permanency are compatible with the DDR under two conditions: (1) a minimum stand-off period of 5 min to ensure that autoresuscitation is impossible and that all brain functions have been lost and (2) no medical intervention is undertaken that might resume bodily or brain circulation. By our analysis, only the Australia heart DCDD programme using a stand-off period of 5 min respects the DDR when the criteria of death are based on permanency.

Is heart transplantation after circulatory death compatible with the dead donor rule?

“…The only justification Dalle Ave et al 3 offer for abandoning irreversibility in favour of permanence is that this ‘conforms to the usual practice of death determination using the circulatory criterion in non-donation circumstances’ (p. 4). This analogy to non-donation circumstances is misleading and irrelevant.…”

“…Some scholars argue that the practice is not—and perhaps even cannot be—consistent with the dead donor rule (DDR), which prohibits procuring vital organs from donors who are not yet dead 1 2. In a recent article, Dalle Ave et al 3 offer what they describe as ‘a rigorous analysis of the acceptability’ of heart donation in DCD (p. 1). By examining several distinct DCD protocols in comparison with a variety of proposed death criteria, they argue that some heart transplantation protocols can be consistent with DDR, but only if criteria for death are chosen based on permanent rather than irreversible cessation of circulatory or brain function.…”

“…Dalle Ave et al 3 write, “If health professionals who practice heart [DCD] protocols wish to comply with the DDR, they should determine death either based on the criterion of permanent cessation of circulation or permanent cessation of brain functions” (p. 5). This appeal to permanence rather than irreversibility of the cessation of functioning is a significant departure from established law and bioethics, yet little justification is offered for this departure.…”

Le don cardiaque après un décès cardiocirculatoire : le cœur du sujet

“…Currently, cardiac DCDD programs exist in Australia, Belgium, and the United Kingdom. 4,5 In Canada, such a cardiac DCDD program does not exist but is advocated for by many healthcare providers in the transplant community. Whether the medical community and society in general are ready for cardiac DCDD is less clear.…”

The price of our illusions and myths about the dead donor rule

“…As such, what is most notable about the paper by Dalle Ave et al 2 is their description of how the transplantation community has twisted themselves into pretzels creating ethical justifications for increasingly contrived ways to extract functioning organs from people deemed to be dead. In so doing, they are sustaining ethical myths and illusions that have ceased to have any face validity in terms of common sense clinical practice.…”